Laws and science changing local philosophy on football injuries

DENNY SIMMONS / Courier & Press Archives
Victor Lebron sits out the seventh race at Ellis Park in preparation for the eighth and final race ... his fourth of the day on July 6, 2012. This was his first week of racing after suffering a concussion at Churchill Downs earlier in the season.

DENNY SIMMONS / Courier & Press

Paul Neidig, Director of Athletics for the EVSC.

JASON CLARK / COURIER & PRESS Archives
Dr. Andrew Saltzman speaks during a news conference as St. Mary’s talking about the newly formed St. Mary’s Concussion Alliance to help area student athletes in November 2011.

Terry Renna / Associated Press Archives
Michael Waltrip climbs out of his car after his qualifying attempt for the NASCAR Daytona 500 auto race at Daytona International Speedway in Daytona Beach, Fla. on Feb. 19, 2012. If Waltrip really wanted to sit down and count up all the concussions he has sustained over a NASCAR career that stretches back nearly 30 years, he’d certainly hit 10 _ and probably keep counting. Safety improvements since Dale Earnhardt’s death in 2001 have gone a long way toward preventing head injuries today, and NASCAR officials have taken steps to improve the way they identify and treat concussions. But Waltrip knows that won’t undo all the hits he took in the 1980s and ‘90s.

AP2012

Keith Srakocic / Associated Press Archives
Mike Watson, a hockey player for the University of Pittsburgh who has been treated for a concussion, demonstrates a stick handling drill he used in his treatment during a tour of the new UPMC Sports Medicine Concussion Program in Pittsburgh. Dr. Micky Collins helped establish the UPMC Sports Medicine Concussion Program in 2000, the first of its kind in the country.$RETURN$$RETURN$

Keith Srakocic / Associated Press Archives
Physical therapist Anne Mucha, left, explains a test she is demonstrating on Quaker Valley High School soccer player Madison MacDonald during a tour of the expanded UPMC Sports Medicine Concussion Program on April 12, 2012, in Pittsburgh. MacDonald suffered a concussion playing soccer and has been receiving treatment at the facility.

AP2012

Sunday's Super Bowl has brought a fresh wave of national conversation about football's long-term health — that of individual players and the sport itself.

Dangerous hits and concussions are commonplace, and not just among well-compensated pros. According to a 2011 Centers for Disease Control and Prevention study, the number of all youth athletes treated for traumatic brain injury has grown 60 percent in the last decade.

Before athletes at Evansville area high schools take the field for game action, their heads must get examined.

"ImPACT testing" establishes baseline data for brain function. It's the same procedure used by the National Football League and numerous colleges.

"It measures their cognitive function pre-concussion, when they are normal, when everything is fine," said Paul Neidig, the Evansville Vanderburgh School Corp. Deputy Chief of Staff and athletics supervisor. "Data is stored, and if (students) have a concussive event, they can go back and retest that student athlete and compare it to where they were pre-concussion."

EVSC has baseline data on all players before the season starts, and it's repeated every two years.

That such testing has filtered down to the high school level shows the increasing priority nationwide on player safety, particularly in football.

Even President Barack Obama weighed in, telling The Atlantic in a recent interview that if he had a son, he would have to think "long and hard" before allowing him to play football, due to the sport's risks.

The NFL is a defendant in more than 200 cases involving more than 4,000 former players, including 12-time All-Pro linebacker Junior Seau, who committed suicide last year at 43. Seau was found to have chronic brain damage. His family sued the league.

Local and national observers point out that injuries including concussions occur in all sports. However, they remain most common in football.

Those involved with football locally say injury risk is, and always has been, inevitable in their sport and all others. But they say awareness about head injuries has grown in recent years, and they cite work on multiple fronts to reduce the risk.

The Tri-State Concussion Alliance was formed three years ago. Participants are the EVSC, Tri-State Orthopedics, St. Mary's Medical Center and Pro Rehab.

"For us, the impact tool has been around longer than three years," Neidig said. "But we were not able to utilize the tool because there were no doctors in Evansville that were trained to read results of the test, and use it."

Enter Dr. Andrew Saltzman, with Tri-State Orthopedics. Saltzman is a surgeon with a specialty in sports medicine, and although head injuries were not his expertise, he decided to get trained as the need arose. Now, about five other local physicians have followed suit.

"It has become the standard of care in concussion management," Saltzman said. "As health care providers, we're not that good in telling how well someone has covered just by talking to them, although that's part of it. But this is a universally accepted way to diagnose a patient."

No athlete can return to activity until their functions return to baseline levels. Athletes are not allowed back on the field because time passes and a headache subsides.

"Our doctors are in total control of the student athletes," Neidig said. "They don't return to the field until they've been cleared by one of doctors that saw the student athlete on the initial concussion. We simply don't allow it, and now, a state law (which took effect July 1) backs us up."

Saltzman works with athletes from multiple local high schools, and he also sees some collegians. Over the course of a school year, he examines more than 100 young men and women with concussion symptoms.

The largest percentage are football players, "but we see quite a few in soccer and a surprisingly high level in cheerleading," Saltzman said. "I've seen swimmers, wrestlers."

There also are cases when an athlete is treated following a nonathletic incident, such as a fall or automobile crash.

Consequences of returning to action too quickly after a head injury can be serious. "The problem is that when they return to play before they are fully recovered, they are more susceptible to another injury and could have symptoms that last much longer," said Saltzman, who was named 2012 Team Physician of the Year by the Indiana State Medical Association and Indiana Athletic Trainer's Association.

Someone does not have to be knocked unconscious to have suffered a concussion, Saltzman said, nor do they even have to be hit in the head.

To Saltzman's points, the most serious concussion to an athlete Mike Goebel has seen during his coaching career at Mater Dei High School occurred on a wrestling mat. It didn'teven involve a blow to the head.

"I had a very good wrestler who was in a situation where his feet were lifted, and the impact from where he hit on the mat showed it did not come in contact with the head," Goebel said.

The wrestler later became very ill and was diagnosed with the head injury, forever leaving an impression on his coach. "It opened my eyes," Goebel said.

Local awareness of the concussion issue has increased greatly in recent years, Goebel said, and he's confident Evansville area schools are at the forefront of prevention, diagnosis and treatment.

"If one athlete had a serious injury because of a situation that could have been prevented, anyone involved would feel badly about it," Goebel said. "Coaches care about players as much of anyone outside of friends and family. Trainers in the city have been proactive in that regard."

Participation and liability

Although concussions from football have received heavy national attention, local coaches haven't seen any drop-off in their numbers of players. Goebel said that at Mater Dei, parents are told at an introductory meeting about ImPACT testing and other safety precautions.

The success of ImPACT testing is diagnosing head injury severity is well-researched, Saltzman said. He said most local parents of athletes with injuries want doctor's orders followed. A select few are more reckless and often are motivated by the possibility of athletic scholarships for their children.

"A few of them say if the athlete can tell how many fingers we're holding up, they can go back in," Saltzman said.

The best protection schools have from liability in concussion injuries is to emphasize safety as much as possible, local officials agreed.

Playing football or any sport "needs to be a family decision," Neidig said. "That's the first place where it has to start. We keep the kids as safe as we can. We try to buy good quality helmets, make sure they fit the kids properly.

"One of the things we're going to institute this fall that we've not done in the past is, I'm going to bring in the helmet manufacturers, and I'm going to make sure every one of our football coaches is trained in proper fit techniques on helmets, and we're going to check every kid. Just so we can do everything we can do on the preventive side of concussions."

Neidig said youth football programs in and around Evansville are vibrant. Bob Zoss, an Evansville attorney, is commissioner of Gold Bears, a youth league with participation mostly in the Central High School district. Zoss played on the Indiana University football team for three years as a walk-on.

Zoss said some youth leagues allow tackling as early as first grade; his does not tackle until third grade. Kindergarten pupils play flag football; grades 1-2 play flag football in full uniform.

There are separate programs for children in grades 3-4 and grades 5-6 "because there's too big a disparity in size and speed," said Zoss, a father of four sons who play at the youth level.

USA Football, a nonprofit national governing body of amateur football that works in partnership with the NFL, produced numerous videos aimed at helping coaches teach safety techniques, including tackling, and the dangers of a defender leading with his helmet when making a tackle. Rule changes in football penalize players for doing that.

"With the advancements that have been made in technology and coaching methods, and the extra emphasis that's been placed on potential head trauma, I think that with proper equipment and training the risk can be greatly minimized," Zoss said. "No sport is without the possibility of injury. But the number of concussive type of injuries we've had in four years of tackle football have been minimal.

"Football is a great sport. It teaches a lot of life lessons. Soccer, they don't have any equipment, and they're using their heads. You have to ask is that any more safe than football."

Neidig said greater concussion awareness needs to permeate across football and all sports. He noted that it used to be common when, after a player went down after a tough hit, for observers to dismissively state that the athlete "just got his bell rung."